How to Improve Care for Medicare Advantage Members with Chronic Conditions

This is the fourth article in a six-part series exploring ways to improve the delivery of whole-person, value-based care to Medicare and Medicare Advantage populations. In this post, we explore strategies to deliver whole-person care for Medicare members with chronic conditions, aiming to improve outcomes and quality of life.

You can also download our white paper Effectively Managing Medicare Populations: 6 Focus Care Areas to get more information and insights about other areas to improve for Medicare plan members. 

According to 2020 data from the Chronic Conditions Data Warehouse (CCW), nearly 32 million Medicare beneficiaries had a chronic condition. And a majority of enrollees often suffer from multiple chronic conditions.

And managing chronic conditions is costly. According to the CDC, nearly 90 percent of the nation’s $4.1 trillion annual healthcare spending is for individuals with chronic and mental health conditions. For Medicare populations, the costs are two-fold: direct costs for managing and treating the condition itself, and indirect costs associated with the condition, such as its impact on other health conditions, mobility, quality of life, and other factors. Individuals with chronic conditions are more likely to have longer and more frequent hospital stays, for example.

Focus on Whole-Person Care for Medicare Members with Chronic Conditions

Empower care teams and members earlier

To improve the management of Medicare members with chronic conditions, health plans need to focus on delivering whole-person care. This requires a holistic approach on both the clinical and care management side, where all team members involved are informed and working collaboratively regarding events, diagnoses, treatments, and interventions.

This way, for example, everyone on a member’s care team is aware that the member saw a podiatrist for diabetes-related neuropathy and

  1. Received a new prescription that may impact other medications,
  2. Is experiencing mobility problems and may need transportation services, and
  3. Received a referral for surgery and will need pre-op education in the near future.

It also means considering all factors that can exacerbate the member’s chronic condition, such as mental health, access to nutrition, health literacy level, socioeconomic concerns, and other social determinants of health.

The Role of Personalization in Value-Based Care for Chronic Conditions

Personalization goes hand-in-hand with whole-person, value-based care. Personalized care journeys help members feel seen, understood, and respected, leading to better engagement – crucial for people with chronic conditions. In fact, a 2021 McKinsey study confirmed that patients who are more deeply engaged in their health because they receive personalized care are more likely to report a better member experience, higher quality of care, and lower avoidable health costs.

In another study, a group of researchers tested the impact of using a person-focused approach with patients with a serious chronic illness. Their conclusion is? Person-focused interventions can improve the patient experience for this population. Interestingly, the study authors noted that people with chronic illness are actually at risk for experiencing de-personalized, over-medicalized care as they age.

How to Improve Chronic Condition Care Management

Improving the management of complex and chronic conditions requires taking a proactive approach to care, empowering patients to be self-advocates and engaged members of their health plan and ensuring any care coordination efforts are seamlessly connected.

With chronic conditions, the earlier they’re addressed, the better. Leaving chronic diseases unaddressed too long can result in extremely expensive and complicated healthcare services and treatments that some members may not be able to afford. Identifying at-risk patients earlier and instituting preventive measures, or taking proactive steps to engage current members with chronic conditions to adhere to medications and care plans, and make healthier choices can result in better health, quality of life, and lower overall healthcare costs.

Member data interoperability and transparency are also essential to creating a connected care ecosystem for seamless care coordination. Payers and providers need to be able to see real-time, up-to-date information as the member transitions between care settings. They also need to be able to use that data to empower care teams to deliver the right care to the right patient at the right time.

HELIOS Can Simplify and Improve Chronic Care and Disease Management

Reducing Complexity, Strengthening Coordination, Increasing Personalization

HELIOS is uniquely configurable to comprehensively address the top challenges in delivering value-based, whole-person care for Medicare members with chronic disease – complexity, coordination, and securing patient engagement. It keeps all care team members aligned and working within the same ecosystem for collaborative decision-making. It eliminates data silos and automates workflows so that care managers can spend more time getting to know members and less time searching through disparate information.

Critically, HELIOS also provides flexibility. Care managers have the autonomy to adapt processes so they can personalize member care, tailoring plans and goals to individual needs and circumstances.

Here’s a more detailed look at how HELIOS supports a better experience for members with chronic conditions

Earlier identification of at-risk patients. A single, 360°-member view generated from data from across care settings gives care teams a complete, real-time story of an individual’s health, including goals, treatments, barriers, progress, and emerging issues (ED visits, medication changes, etc.). AI-driven insights help care managers to quickly identify the members who should receive preventive assessments and screenings, enabling early diagnosis and intervention.

Prioritizing care management efforts. Integrated identification and stratification capabilities guide care coordinators toward high-risk cases, ensuring proactive activity for the situations where it is needed most. And, built-in clinical and care management pathways recommend best practices for clinical treatment of chronic diseases.

A connected data ecosystem for coordinated care. HELIOS offers a single centralized ecosystem to power care team collaboration as individual members transition between acute care settings, long-term facilities, and the community. Event-driven triggers coupled with real-time admission, discharge and transfer (ADT) feeds ensure that care teams are promptly notified and tasked with the next best action. And during coordination efforts, assessments, screening tools and other interactions help care team staff by surfacing only relevant fields and pre-populating information wherever possible to simplify and streamline efforts.

Automations to reduce administrative burden and expand caseload capabilities. HELIOS automatically assigns the appropriate care team members and generates tasks, which helps reduce the administrative burden on staff members and makes it possible for care teams to handle larger caseloads with no adverse impact on quality. This is especially key for large populations, where efficiency and effectiveness both matter.

Stronger member engagement through educational resources. Care managers can quickly package up personalized content to help members better understand conditions and engage in self-management. With HELIOS, users can leverage healthcare education content from leaders like HealthWise, as well as integrate their own custom content. (Learn about HELIOS + HealthWise  .)

Read: 11 Ways HELIOS Can Help Payers with Complex Medicare Populations for even more.

H3: Learn More About How to Improve Medicare Population Health Management

Check out the other five posts in this series to see how to improve medication adherence and outcomes for members who need additional support and services.

How Can Medicare Payers Better Support Home Health Care?


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